F-75 is the "starter" formula used during initial management of malnutrition, beginning as soon as possible and continuing for 2-7 days until the child is stabilized. Severely malnourished children cannot tolerate normal amounts of protein and sodium or high amounts of fat. They may die if given too much protein or sodium. They also need glucose, so they must be given a diet that is low in protein and sodium and high in carbohydrate. F-75 has is specially mixed to meet the child's needs without overwhelming the body's systems in the initial stage of treatment. Use of F-75 prevents deaths. F-75 contains 75 kcal and 0.9 g protein per 100 ml.

As soon as the child is stabilized on F-75, F-100 is used as a "catch-up" formula to rebuild wasted tissues. F-100 contains more calories and protein: 100 kcal and 2.9g protein per 100 ml.

The table below shows a number of recipes. The choice of recipe may depend on the availability of ingredients, particularly the type of milk, and the availability of cooking facilities.

The principle behind the recipes is to provide the energy and protein needed for stabilization and catch-up. For stabilization (F-75), it is important to provide a formula with the energy and protein as shown (no less and no more). For catch-up (F-100), the recipes show the minimum energy and protein contents needed.

The first three recipes given for F-75 include cereal flour and require cooking. The second part of the table shows recipes for F-75 that can be used if there is no cereal flour or no cooking facilities. However, the recipes with no cereal flour have a high osmolarity (415 mOsmol/l) and may not be tolerated well by some children with diarrhoea.

The F-100 recipes do not require cooking as they do not contain cereal flour.

It is hoped that one or more of the recipes can be made in your hospital. If your hospital cannot use any of the recipes due to lack of ingredients, seek expert help to modify a recipe using available ingredients.

Recipes for F-75 and F-100

If you have cereal flour and cooking facilities, use one of the top three recipes for F-75:

Alternatives

Ingredient

Amount for F-75

If you have driedskimmed milk

Dried skimmed milk

25 g

Sugar

70 g

Cereal flour

35 g

Vegetable oil

30 g

Mineral mix*

20ml

Water to make 1000 ml

1000 ml**

If you have driedwhole milk

Dried whole milk

35 g

Sugar

70 g

Cereal flour

35 g

Vegetable oil

20 g

Mineral mix*

20 ml

Water to make 1000 ml

1000 m/**

If you have freshcow's milk, or full-cream (whole)long life milk

Fresh cow's milk, or full-cream(whole) long life milk

300ml

Sugar

70 g

Cereal flour

35 g

Vegetable oil

20 g

Mineral mix*

20 ml

Water to make 1000 ml

1000 ml**

If you do not have cereal flour, or there are no cookingfacilities, use one of the following recipes for F-75:

** Important note about adding water: Add just the amount of water needed to make 1000 ml of formula. (This amount will vary from recipe to recipe, depending on the other ingredients). Do not simply add 1000 ml of water as this will make the formula too dilute. A mark for 1000 ml should be made on the mixing container for the formula so that water can be added to the other ingredients up to this measure.

Add water just up to 1000 ml mark

Mineral mix

The mix contains potassium, magnesium and other essential minerals. It must be included in F-75 and F-100 to correct electrolyte imbalance. The mineral mix may be made in the pharmacy of the hospital or a commercial product called Combined Mineral Vitamin Mix (CMV) may be used to provide the necessary minerals.

Vitamins

Vitamins are also needed in or with the feed. Children are usually given multivitamin drops as well. The multivitamin preparation should not include iron.

If available, CMV may be used to provide the necessary vitamins. If CMV is used separate multivitamin drops are not needed.

Correct position to feed a severely malnourished child with F75 and F100

Mix oil well so that it does not separate. If oil floats to the top of the mixture, there is a risk that some children will get too much and others too little. Use a long hand whisk to thoroughly mix the oil.

Be careful to add the correct amount of water to make up 1000 ml of formula. If 1000 ml of water is mistakenly added, the resulting formula will be about 15% too dilute.